Renal Ultrasound Research Articles

High prevalence of chronic kidney disease and its related risk factors in rural areas of Northeast Thailand

In Thailand, chronic kidney disease (CKD) screening was reported in 2009 with an overall prevalence of 17.5% and the highest at 22.2% in the northeastern region. This study aimed to find out CKD prevalence of the Kidney Disease Improving Global Outcomes criteria and their related risk factors in the rural community. A population-based study was conducted in the rural sub-districts of northeastern Thailand. Data of socio-demographic status, lifestyle, underlying diseases, blood pressure, and body mass index were recorded. Blood and urine analysis was conducted along with ultrasonography of kidneys. Specimen collection and analyses were repeated after 3 months, and the factors associated with CKD were studied by logistic regression analysis. A total of 2205 participants with a mean age of 57.8 ± 11.7 years and female predominance (66.7%) completed the study. The prevalence of CKD was 26.8%, i.e., stages 1 (7.3%); stage 2 (9.0%); stage 3a (6.0%); stage 3b (2.8%); stage 4 (1.4%); and stage 5 (0.3%). Hypertension, diabetes mellitus, and renal stones were the major underlying diseases. Only 3.5% of the participants were aware of having CKD. An increase in age, male, unemployment, current smoking, diabetes, hypertension, underweight, anemia, hyperuricemia, and leukocytosis were significantly associated factors with the disease. The study revealed that CKD has developed as a significant public health problem in rural northeastern Thailand and one out of every four people has CKD. Therefore, early interventions are essential for the proper management and prevention of CKD.

Imaging Practices and Implications in Young Infants With Urinary Tract Infection.

Management of infants aged ≤60 days with urinary tract infections (UTI) is challenging. We examined renal imaging in infants aged ≤60 days with UTI at a tertiary care children's hospital to identify the impact of standardizing renal ultrasound (RUS) interpretation. We retrospectively studied infants aged ≤60 days hospitalized for UTI or fever with urine culture and renal imaging obtained and final diagnosis of UTI. RUS initially had noncriterion-based (NCB) interpretation by experienced pediatric radiologists. For this study, a single pediatric radiologist used a criterion-based (CB) hydronephrosis grading system to reinterpret films initially classified as "abnormal" on the NCB reading. We compared final renal imaging results between NCB and CB groups. Of 193 infants, 180 (93%) had inpatient RUS with 114 (63%) abnormal NCB interpretation. Of those with initially abnormal NCB interpretation, 85 OF 114 (75%) had minor and 29 OF 114 (25%) had significant abnormality by CB reinterpretation. In follow-up, the CB "minor abnormality" group showed 25% abnormal renal imaging, whereas the "significant abnormality" group showed 77% abnormal renal imaging with 54% having high-grade reflux on a voiding cystourethrogram (VCUG). Patients with CB inpatient RUS minor abnormality showed 3% abnormal RUS at follow-up, but 13% showed high-grade reflux on VCUG. Standardized RUS interpretation in young infants with UTI improved the accuracy of identification of abnormalities on follow-up renal imaging. In patients with CB minor abnormality on inpatient RUS, our results suggest limited utility of follow-up RUS; however, follow-up VCUG remained useful to identify high-grade reflux.

National Assessment of Ear Abnormalities as Predictors for Renal Abnormalities

PURPOSE: Ear malformations and renal abnormalities are established to have some level of association. However, there is still ongoing debate regarding the utility, cost-effectiveness, and overall need to screen children with ear malformations for renal abnormalities. Herein, we utilized the 2016 Kids’ Inpatient Database (KID) to examine the association and relationship between different types of ear abnormalities commonly seen in children and renal abnormalities. METHODS: KID is a large national inpatient database that compiles admissions and data regarding diagnosis, race, procedures etc. Patients who had ICD-10 diagnoses of ear abnormalities (Q17) were identified. Those without ear abnormalities served as the control group. Patients with renal malformations (Q60 and Q63) were identified. Logistic regression was then conducted to analyze if patients with ear malformations had significantly different odds of having renal malformations. Statistical analyses were conducted in STATA using an α<0.05 for determining significance of predictors. RESULTS: 8324 patients were identified with ear abnormalities. 5321 patients were identified with congenital renal abnormalities. Those with microtia were found to be 8.83 times more likely to have congenital renal abnormalities compared to those without. Those with an accessory auricle were 3.5 times more likely to have renal abnormalities compared to those without. Those with a diagnosis of other specified ear abnormalities and other unspecified were found to be 5.92 and 7.75 times more likely to have renal abnormalities compared to those without respectively. Those patients with a congenital misplaced ear were 9.66 times more likely to have renal malformations compared to those without. Figure 1 Additionally, we examined renal agenesis as in relation to ear abnormalities. 4784 patients were identified with renal agenesis. Patients with microtia were found to be 18.17 times more likely to have renal agenesis compared to those without. Those with an accessory auricle were 4.01 times more likely to have renal agenesis compared to those without. Patients with a misplaced ear were 14.40 times more likely to have renal agenesis compared to those without. Those with other specified and unspecified ear abnormalities were found to be 8.11 and 8.48 times more likely to have renal agenesis compared to those without respectively. Patients an other mishappen ear were 4.68 times more likely to have renal agenesis compared to those without. Figure 2 CONCLUSIONS: Our results indicate a clear association between specific ear abnormalities and renal abnormalities. As such, there may be clinical value and supportive evidence for conducting screening tests such as renal ultrasounds on pediatric patients who present for ear abnormalities. To our knowledge, this is the first study to evaluate the association of specific ear abnormalities and renal abnormalities using a national database. These associations may aid clinicians in pursuing screening regimens for patients with congenital ear anomalies.

Imaging characteristics predicting elevated detrusor pressures in patients with spina bifida

Patients with spina bifida require urologic follow up with assessments of bladder and renal function. The ideal screening protocol for bladder compliance remains controversial. This study assessed associations between bladder end filling pressure (EFP) and detrusor leak point pressure (DLPP) on urodynamic studies (UDS) and findings from renal bladder ultrasounds (RBUS) and voiding cystourethrograms (VCUG). Pediatric spina bifida patients who underwent RBUS and/or VCUG within six months of UDS at a single institution from 2015 to 2021 were retrospectively reviewed. Demographics, VCUG and RBUS results, and UDS EFP and DLPP were recorded. Multiple linear regression analyses and Pearson chi-square tests were conducted to correlate RBUS and VCUG findings with DLPP/EFP. 129 patients were included. In adjusted analyses, moderate to severe hydronephrosis on RBUS was significantly associated with elevations in mean DLPP/EFP (p=0.006). Patients with round bladders had significantly lower mean DLPP/EFP than patients with elongated or conical bladders (p<0.0001). The presence of trabeculations was associated with increased mean DLPP/EFP (p<0.0001) and increases in severity of trabeculations were associated with higher DLPP/EFP (p<0.0001). The presence of vesicoureteral reflux (VUR) on VCUG was not associated with significant differences in mean DLPP/EFP (p=0.20). Abnormal bladder shape and trabeculations on VCUGs in spina bifida patients had significant associations with increased mean bladder pressures on UDS. Assessment of bladder shape and contour by VCUG may be a valuable screening tool in conjunction with routine RBUS in determining the need for further assessment of bladder pressures in patients with spina bifida.

Is technetium-99m dimercaptosuccinic acid renal scintigraphy available for predicting vesicoureteral reflux in children with first febrile urinary tract infection under the age of 24 months?

Vesicoureteral reflux (VUR) is a common complication after urinary tract infection (UTI) and can lead to irreversible renal scar. Voiding cystourethrogram is the most reliable technology to detect VUR and its severity, but it is restricted in children's examinations for various shortcomings. This study aimed to evaluate and compare the efficiency of Tc-99m DMSA renal scintigraphy and conventional ultrasonography (USG) in predicting VUR with the gold standard of cystourethrogram results. This retrospective study consisted of 285 first febrile UTI children under the age of 24 months who completed inflammatory indicator examinations, USG, Tc-99m DMSA renal scintigraphy and underwent cystourethrography after controlling infection with prophylactic antibiotics. The efficiency of Tc-99m DMSA renal scintigraphy and USG in predicting VUR was calculated and compared. Abnormal USG (40.23% vs. 21.72%, P = 0.001) and Tc-99m DMSA renal scintigraphy results (87.36% vs. 71.72%, P = 0.004) were more common in VUR children. The sensitivity of USG in predicting VUR was only 40.23%, whereas the sensitivity and negative predictive value of Tc-99m DMSA renal scintigraphy reached 87.63 and 83.58%, respectively. Tc-99m DMSA renal scintigraphy had a higher efficacy than USG in predicting high-grade reflux kidneys (73.87% vs. 33.33%; P < 0.001), but there was no significant difference in predicting low-grade reflux kidneys ( P = 0.703). Tc-99m DMSA renal scintigraphy had a significant higher efficiency in predicting VUR (a common cause of renal scarring, detected on DMSA) in first febrile urinary tract infection children under the age of 24 months as compared with USG, especially in high-grade reflux.

Ultrasound Kidney Images with IKNN-Dependent FPGA Abnormality Classification

Ultrasound imaging is commonly used to diagnose internal anomalies. Imaging for abnormality detection is a challenging process in today’s world. Even though there is an advancement in technology, tele-radiographers face difficulty in the accurate diagnosis of abnormalities. In order to resolve this issue, tele-radiology has paved a new way for doctors around the world to access the Internet to share the radiological images from one location to another. But frequent online access is one of the bottleneck issues. In order to overcome this drawback, Computer Assisted Diagnosis (CAD) is preferred in this proposed study and it uses VIRTEX-6 FPGA to clearly identify abnormality in the platform and also manual control is minimized in this condition. The proposed algorithm includes five steps: pre-processing, segmentation, feature extraction, selection and classification. The classification is performed using the Iterative K-Nearest Neighbor (IKNN) classifier based on the selected features. Unlike popular KNN, the proposed IKNN algorithm performs the similarity measurement on selective neighbors for a number of times where the number of neighbors has been dynamically selected at each iteration. Also, at each iteration, the method would select a subset of features in a random way. For the features selected and with the neighbors selected, the method computes the similarity value of Hist-sim which is being measured according to the features selected from the histogram features where the method computes the Haralick similarity with the features selected from the Haralick features. Using the features selected, the method computes the value of cumulative class drive similarity (CCDS). At each iteration the class with maximum similarity is selected and finally, the class being selected for the most number of times is selected as a result of classification. This improves the performance of classification. While comparing with the existing algorithms such as Support Vector Machine (SVM) with the linear, Radial Basis Function (RBF) and polynomial kernels, greater accuracy is achieved via IKNN classification. The specificity is found to be 95, 80 and 75 for normal, cystic and stone kidneys.

Asymmetric U-shaped network with hybrid attention mechanism for kidney ultrasound images segmentation

Kidney ultrasound (KUS) images segmentation is one of the key steps in computer-aided diagnosis. The perturbation of heterogeneous structure, similar intensity distribution, and kidney morphology pose challenges for the segmentation of KUS images. In this paper, we proposed an asymmetric U-shaped network based on the U-net core architecture to segment KUS images accurately and reliably. Specifically, the architecture mainly consists of a dense residual connection encoder, a multi-step up-sampling decoder with the hybrid attention module, and a side-out deep supervision module. The design of the dense residual connection encoder can capture sufficient kidney feature information to improve the representation ability of the network. The development of the hybrid attention module can further guide the network to pay more attention to the representation of the kidney. In addition, the introduction of the side-out deep supervision model can help the network obtain segmentation results that are closer to the ground-truth masks. Moreover, to reduce network parameters, we proposed a multi-step up-sampling optimization strategy to simplify the design of the network. We compare with several state-of-the-art medical image segmentation methods on the same KUS dataset using seven quantitative metrics. The results of our method on Jaccard, Dice, Accuracy, Recall, Precision, ASSD and AUC are 89.95%, 94.59%, 98.65%, 94.47%, 95.07%, 0.3006 and 0.9703, respectively. Experimental results demonstrate that the proposed method achieves the most competitive segmentation performance on KUS images.

Clinical and genetic characterization of children with cubilin variants.

Cubilin is one of the receptor proteins responsible for reabsorption of albumin in proximal tubules and is encoded by the CUBN gene. We aimed to evaluate clinical and genetic characterization of six patients with proteinuria who had CUBN mutations. Patients' characteristics, serum creatinine, albumin, vitamin B12 levels, urine analysis, spot urine protein/creatinine, microalbumin/creatinine, beta-2 microglobulin/creatinine ratios, estimated glomerular filtration rates (eGFR), treatments, kidney biopsies, and genetic analyses were evaluated. Six patients (2 female, 4 male) with an incidental finding of proteinuria were evaluated. Mean admission age and follow-up time were 7.3 ± 2.9 and 6.5 ± 5.6years, respectively. Serum albumin, creatinine, and eGFR were normal; urine analysis revealed no hematuria, and C3, C4, ANA, and anti-DNA were negative; kidney ultrasonography was normal for all patients. Urine protein/creatinine was 0.9 ± 0.3mg/mg, and microalbumin was high in all patients. Serum vitamin B12 was low in two patients and normal in four. Kidney biopsy was performed in four patients, three demonstrated normal light microscopy, and there was one focal segmental glomerulosclerosis (FSGS). Genetic tests revealed four homozygous and two compound heterozygous mutations in the C-terminal part of cubilin. All patients had normal eGFR and still had non-nephrotic range proteinuria at last visit. CUBN gene mutations should be considered in patients with isolated non-nephrotic range proteinuria and normal kidney function. Diagnosing these patients, who are thought to have a better prognosis, is important in terms of avoiding unnecessary treatment and predicting prognosis. CUBN gene mutations may also present as FSGS which extends the spectrum of renal manifestation of these patients. A higher resolution version of the Graphical abstract is available as Supplementary information.

Renal Artery Aneurysm Mimicking Nephrolithiasis: A Case Report and Review of Literature

While originally described in the 18th century, the incidental detection of renal artery aneurysms (RAAs) has increased significantly with the advent and increased usage of modern cross-sectional imaging. Although the incidence remains low, RAAs are clinically important, especially if measuring greater than 2 cm in diameter. Therefore, ultrasonographers and radiologists alike should be aware of its features on multiple imaging modalities as well as imaging pitfalls. Renal duplex sonography is widely used for the evaluation of renal arteries stenosis, fibromuscular dysplasia, renal veins patency, and for the status of renal transplants. RAA is another, albeit rare, indication for renal arteries duplex examination. Furthermore, RAAs may be an incidental finding on abdominal or renal ultrasound. Therefore, familiarity with the sonographic presentation of a RAA is important. Diagnosing RAAs with duplex ultrasound may become exceptionally difficult when the aneurysm has peripheral calcification, even more so when the aneurysm is situated by the renal hilum. Those calcified arterial walls may produce strong acoustic shadowing, mimicking a renal calculus.

Evaluation of screening with urine dipsticks and renal ultrasonography for 3-year-olds in Chiba City over 30years.

Urinary screening for 3-year-olds cannot adequately detect congenital anomalies of the kidney and urinary tract (CAKUT). Urinary screening for 3-year-olds was investigated over 30years. Dipsticks for proteinuria, hematuria, glycosuria, leukocyturia, and nitrite at first screening, and dipsticks, urinary sediments, and renal ultrasonography at second screening were performed. Screening results were evaluated. The positive rates of proteinuria, hematuria, leukocyturia, and nitrite relative to 218,831 children at the first screening were 1.0%, 4.6%, 2.3%, and 0.88%, respectively. Thirty-seven glomerular disease, 122 CAKUT, and 5 urological disease cases were found. We detected 6 stage 3-4 chronic kidney disease (CKD) and 3 end-stage kidney disease cases, including 3 CAKUT, comprising 2 bilateral renal hypoplasia and 1 vesicoureteral reflux (VUR), and 6 glomerular diseases, comprising 4 focal segmental glomerulosclerosis and 2 Alport syndrome. The positive rates relative to 218,831 children and CKD detection rates for each tentative diagnosis of mild hematuria, severe hematuria, proteinuria and hematuria, proteinuria, and suspected urinary tract infection were 1.4% and 0.67%, 0.11% and 3.7%, 0.01% and 28.6%, 0.02% and 45.0%, and 0.08% and 9.7%, respectively. Among 14 VUR cases with significant bacteriuria, 13 were found by leukocyturia, 12 had grade ≥IV VUR, and 10 had severe renal scars. Nine stage 3-5 CKD cases comprising 3 CAKUT and 6 glomerular disease were found by urinary screening of 3-year-olds among 218,831 children. The combination of urine dipsticks including leukocyturia at the first screening and ultrasonography at the second screening appeared useful.

An audit of renal ultrasounds for new referrals to the nephrology outpatients service

Background: The National Institute for Health and Care Excellence (NICE) (2021) guidelines for the assessment and management of chronic kidney disease set out indications for ordering renal ultrasounds. Aim: The aim of this audit was to identify the number of renal ultrasounds ordered for new referrals to a nephrology outpatient service, whether the reason for these ultrasounds met the NICE guidelines, how many ultrasounds were ordered for each indication and whether the outcome of the scan was normal or abnormal. Findings: There were 287 referrals to the nephrology outpatient service, which were reviewed as to whether the ultrasound request met the guidelines. From the 278 new referrals, 139 had a renal ultrasound ordered. Of these, 57 met the criteria for having an ultrasound, while 82 requests did not meet the guidelines. Conclusion: This audit highlights the frequency with which inappropriate ordering occurs, as well as the ongoing need for education amongst clinicians on appropriate indications and the potential cost deficits involved.

Association of hypercalciuria with vitamin D supplementation in patients undergoing ketogenic dietary therapy.

BackgroundKetogenic dietary therapy (KDT) is used as an effective treatment for epilepsy. However, KDT carries the risk of bone health deterioration; therefore, vitamin D supplementation is required. Vitamin D replacement therapy in KDT has not been established because it may be related to hypercalciuria/urolithiasis, which are common adverse effects of KDT. Hence, this study aimed to evaluate the dose-dependent association between vitamin D3 and hypercalciuria/urolithiasis in patients undergoing KDT and dose optimization for renal complications.Materials and methodsOverall, 140 patients with intractable childhood epilepsy started 3:1 KDT (lipid to non-lipid ratio) at the Severance Children’s Hospital from January 2016 to December 2019. Regular visits were recommended after KDT initiation. Participants were assessed for height, weight, serum 25-hydroxyvitamin D (25-OH-D3) level, parathyroid hormone level, and ratio of urinary excretion of calcium and creatinine (Uca/Ucr). Kidney sonography was conducted annually. Patients who already had urolithiasis and were taking hydrochlorothiazide before KDT, failed to maintain KDT for 3 months, did not visit the pediatric endocrine department regularly, did not take prescribed calcium and vitamin D3 properly, or needed hospitalization for > 1°month because of serious medical illness were excluded. Data from patients who started diuretic agents, e.g., hydrochlorothiazide, were excluded from that point because the excretion of calcium in the urine may be altered in these patients.ResultIn total, 49 patients were included in this study. Uca/Ucr ratio significantly decreased with increasing levels of 25-OH-D3 (p = 0.027). The odds ratio for hypercalciuria was 0.945 (95% confidence interval, 0.912–0.979; p = 0.002) per 1.0 ng/mL increment in 25-OH-D3 level. Based on findings of receiver operating characteristic curve analysis and Youden’s J statistic, the cut-off 25-OH-D3 level for preventing hypercalciuria was > 39.1 ng/mL at 6 months. Furthermore, the vitamin D3 supplementation dose cut-off was > 49.5 IU/kg for hypercalciuria prevention.ConclusionAn inverse relationship between Uca/Ucr ratio and 25-OH-D3 level was noted, which means that vitamin D supplementation is helpful for preventing hypercalciuria related to KDT. We suggest that the recommended 25-OH-D3 level is > 40 ng/mL for hypercalciuria prevention and that KDT for children with epilepsy can be optimized by vitamin D3 supplementation at 50 IU/kg.

39-Year-Old Woman With Severe Weakness

39-Year-Old Woman With Severe Weakness

P13.06: Valve Bladder Diversion, Making Possible a Kidney Transplant

Introduction: The late diagnosis in a patient with posterior urethral valve (PUV) and end-stage kidney disease is a challenging scenario which may need renal replacement therapy and reconstruction of the urinary tract. Reducing recurrent urinary tract infections (UTI) is the main urologic objective in these patients in order to offer them a kidney transplantation (KT). Many factors must be considered to define the best moment to perform the reconstruction, that could be done prior, during or after kidney transplantation. Patient and Method: This is a 5-year-old boy who was admitted for febrile urinary tract infection. During the admission end-stage kidney disease and PUV were diagnosed. The first step was to perform a cystoscopy and valvular ablation. Videourodynamyc studies after surgery showed a bladder’s capacity of 50 ml, low compliance, incomplete emptying associated with high grade bilateral vesicoureteral reflux. Hemodialysis began as renal replacement therapy, antibiotic prophylaxis and anticholinergics were indicated. Four months later, an open vesicostomy was performed due to persistent febrile urinary tract infections. Eleven months after diagnosis, the patient was transplanted using a graft from a deceased donor. At the same time of transplant surgery, the right kidney and ureter were resected through a right hockey stick incision. Two months after transplantation another endoscopic residual valve ablation was done. After seventeen months from kidney transplant, the left kidney and ureter were resected by laparoscopy. Urodynamic studies continued showing high voiding detrusor pressure. While patient kept his bladder diverted, incontinence was managed with five diapers a day and maintained scholar and physical activities. At two years of follow-up, a third valvular endoscopic revision and ablation was performed associated with circumcision and replacing the open vesicostomy with a suprapubic tube. Intermittent opening was indicated and after three months, the tube was removed. Six months after the last surgery, bladder’s capacity improved from 100 ml to 250 ml, bladder emptying has no residual volume and no incontinence. Kidney ultrasonography did not present hydronephrosis and cystography showed no VUR. Twenty nine months after KT the patient remained urinary tract infections free, creatinine level was 0.68 mg/dL and clearance 102 ml/min/1.73 m2. Conclusion: Open vesicostomy is a simple and safe procedure to manage UTI and allows kidney transplant in PUV valve bladders. Urological surveillance after transplant involves clinical assessment, urodynamic studies, endoscopic and reconstructive surgeries. Bladder cycling after transplant improves storage and augmentation procedures may not be needed.

An Unusual Etiology of Proteinuria and Hematuria in a Case with IgA Vasculitis Nephropathy: Nutcracker Syndrome

IgA vasculitis is the most frequent type of vasculitis in children and progresses with the involvement of skin, gastrointestinal system, joints and glomerulonephritis. The most frequent findings of IgAV nephritis are microscopic hematuria and proteinuria ranging from trace amounts to nephrotic levels. The nutcracker syndrome (NCS) is a phenomenon that refers to compression of the left renal vein between the abdominal aorta and superior mesenteric artery. The presenting manifestations are hematuria, orthostatic proteinuria, abdominal pain or left flank pain. Herein we reported a case diagnosed with NCS with regard to persistent microscopic hematuria, intermittent macroscopic hematuria and a fluctuating proteinuria in non-nephrotic levels during the follow up of IgA vasculitis nephritis. A 4,5 year-old boy with rashes extending from the dorsal foot to the sacral regions, arthritis of the ankles and abdominal pain had been admitted to hospital and diagnosed with IgA vasculitis. The total urine analysis revealed +3 proteinuria, and +2 erythrocyte. Nephrotic range of proteinuria was detected in 24-hour urine analysis. The renal biopsy was in accordance with grade II IgA vasculitis nephritis according to the ISKDC classification. The patient was started on an ACE inhibitor and fish oil. In further follow-up, intermittent microscopic hematuria and non-nephrotic range of proteinuria reappeared. The amount of proteinuria was measured in the urine collected during the daytime and the nighttime urine and it was observed that the proteinuria was orthostatic. The patient was re-evaluated regarding etiologies for proteinuria and hematuria. Renal Doppler ultrasonography revealed that the angle between the abdominal aorta and SMA was 14 degrees. Abdominal computed tomography angiography demonstrated that the left renal vein was trapped between aorta and SMA, so the case was diagnosed with NCS. In conclusion, non-glomerular etiologies should be kept in mind in the differential diagnosis of patients with hematuria and/or proteinuria although they are being followed for glomerular pathologies.

Tumor predisposition syndromes and nephroblastoma : Early diagnosis with imaging

The Beckwith-Wiedemann spectrum (BWSp) as well as the WT1-related syndromes, Denys-Drash syndrome (DDS) and WAGR spectrum (Wilms tumor, Aniridia, genitourinary anomalies and arange of developmental delays) are tumor predisposition syndromes (TPS) of Wilms tumor (WT). Patients with associated TPS are at higher risk of developing chronic kidney disease and bilateral and metachronous tumors as well as nephrogenic rests. Standard imaging diagnostics for WT include renal ultrasound and magnetic resonance imaging (MRI). In the current renal tumor studies Umbrella SIOP-RTSG 2016 and Randomet 2017, thoracic computed tomography (CT) is also recommended as standard. Positron emission tomography (PET)-CT and whole-body MRI, on the other hand, are not part of routine diagnostics. In recent publications, renal ultrasound is recommended every 3months until the age of 7years in cases of clinical suspicion or molecularly proven TPS. Patients with TPS and regular renal ultrasounds have smaller tumor volumes and lower tumor stages at WT diagnosis than patients without such ascreening. This allows areduction of therapy intensity and facilitates the performance of nephron sparing surgery, which is prognostically relevant especially in bilateral WT. Early diagnosis of WT in the context of TPS ensures the greatest possible preservation of healthy and functional renal tissue. Standardized screening by regular renal ultrasounds should therefore be firmly established in clinical practice. The initial diagnosis of TPS is clinical and requires askilled and attentive examiner in the presence of sometimes subtle clinical manifestations, especially in the case of BWSp. Clinical diagnosis should be followed by genetic testing, which should then be followed by sonographic screening.

Detection rate with routine postoperative renal ultrasound to identify urinary tract injury after gynecological surgery

The aim of this study was to establish the rate at which routine postoperative renal ultrasonography is able to detect urinary tract injury following gynecological surgery. A retrospective analysis was carried out for the study period 2015-2019 of all patients who had undergone subtotal or total hysterectomy, or radical hysterectomy or salpingectomy, salpingo-oophorectomy, or oophorectomy, and subsequently had a urinary tract injury. In a total of 2068 patients, 25 urinary tract injuries occurred (1.21%), including 21 urinary bladder lesions (1.02%) and four ureteral injuries (0.19%). The incidence of urinary tract injuries was 3% in oncologic procedures and 0.86% in procedures for benign disease. Nineteen injuries (76%) were diagnosed intraoperatively, and six injuries (24%) were clinically diagnosed after surgery. All of the patients had uneventful postoperative renal ultrasound examinations. Routine postoperative renal ultrasonography was not capable of diagnosing urinary tract injuries after gynecologic surgery. Routine postoperative renal ultrasound examinations should, therefore, not be performed after gynecologic operations.

Elevated renal resistive index is independently predicted by older age, but not by the presence of chronic kidney disease: a retrospective cohort study

Renal resistive index (RRI), which reflects intrarenal arterial impedance, is routinely measured when undertaking renal Doppler ultrasonography (RDU). Increased RRI has been suggested to reflect renal parenchymal disease and imply risk of kidney disease progression. But this has been disputed and extra-renal haemodynamic factors rather than intra-renal factors have been proposed to determine RRI. To investigate the relationship between elevated RRI and presence of chronic kidney disease (CKD), and examine whether elevated RRI at baseline is associated with decline in estimated glomerular filtration rate (eGFR) on follow up. This retrospective observational study examined the association of elevated RRI (>0.7) with the presence of CKD (eGFR < 60 mL/min for >3 months), demographic and clinical factors in multivariable models. We also examined the effect of elevated RRI on eGFR decline on follow up using mixed models. Of the 346 patients undergoing RDU (median age 69.7 years; 46.2% male), 180 had elevated RRI. There was a strong inverse association between RRI and eGFR at baseline, 1 and 2 years (rho = -0.53, -0.51, -0.53, all P < 001). Elevated RRI was independently predicted by older age (odds ratio 3.29; 95% confidence interval 2.25-4.8; P < 0.001) and diabetes (odds ratio 2.65; 95% confidence interval 1.21-5.80; P = 0.015), but not CKD using multivariate logistic regression. Decline of eGFR was not different between RRI categories on follow up. Elevated RRI was predicted by older age and diabetes, but not by the presence of CKD. Baseline RRI was not associated with eGFR decline.

Sulfasalazine related nephrolithiasis in patients with rheumatoid arthritis and ankylosing spondylitis

Background Sulfasalazine (SSZ) is an anti-inflammatory and immunomodulatory drug used to treat many inflammatory diseases. Bacteria in the gut metabolize SSZ to active 5-aminosalicylic acid and inactive sulfapyridine. Sulfapyridine can crystallize in the kidney. We aimed to investigate the frequency of nephrolithiasis in patients who were diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and who received SSZ treatment retrospectively.&#x0D; Material and Methods We retrospectively analyzed the files of AS and RA patients in the rheumatology outpatient clinic between 2009 and 2018. We identified patients who underwent kidney ultrasonography at least six months after initiation of SSZ. One hundred six patients and 50 healthy adults were included in the study.&#x0D; Results Only eight patients (6 AS, 2 RA) had nephrolithiasis on ultrasonography, but none in the control group (p=0.046). In logistic regression analysis, no correlation was found between gender, age, vitamin D, parathyroid hormone, and urinary calcium excretion with SSZ use (p&gt;0.05). &#x0D; Conclusion Although, it is noteworthy that these patients are prone to stone formation for various reasons. Therefore, paying attention to the patient’s hydration while using these drugs may prevent such side effects.

Clinicopathological evaluation of our patients with ultrasound assisted percutaneous kidney biopsy

Aim: This study aims to determine the frequency of kidney diseases based on histological diagnosis and to evaluate the relationship between clinical and histopathological findings in patients undergoing percutaneous kidney biopsy for various indications. Material and Method: In this cross-sectional study, demographic, anthropometric and laboratory data of the patients were obtained retrospectively from medical files and computer records. Biopsy indications and histopathological diagnoses (primary glomerular diseases, secondary glomerular diseases, tubulointerstitial diseases and other causes) of the patients were examined. Results: Of 103 patients, 57 (55.3%) were male and 46 (44.7%) were female. The mean age of the patients was 44.67±15.29 years. The most common biopsy indication was hematuria+proteinuria+renal dysfunction (n=28, 27.2%). The most common pathology in histopathological diagnoses was primary glomerular diseases (56.3%), the most common diagnosis was IgAN (n=16, 15.5%). Tubulointerstitial diseases were seen more frequently in the 60 years and older group. (n=4, 25%). The most common cause of secondary glomerulonephritis was AA amyloidosis. The number of tubular disorders increased with advanced age. Conclusion: In our center, renal biopsy was performed most frequently with the combination of proteinuria, hematuria, and renal dysfunction. The most common histopathological result was primary glomerulonephritis, in which IgAN took the first place.